National patterns of care for early-stage penile cancers in the United States: How is radiation and brachytherapy utilized?
Per American Brachytherapy Society guidelines, cT1-2N0 penile cancers 70, lesions >2 cm, and T2 tumors were more likely to undergo non–organ-preserving therapy vs. radiation or a cosmesis-preserving procedure (all p
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| Veröffentlicht in: | Brachytherapy 2019-07, Vol.18 (4), p.503-509 |
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| container_title | Brachytherapy |
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| creator | Mulherkar, Ria Hasan, Shaakir Wegner, Rodney E. Verma, Vivek Glaser, Scott M. Kalash, Ronny Beriwal, Sushil Horne, Zachary D. |
| description | Per American Brachytherapy Society guidelines, cT1-2N0 penile cancers 70, lesions >2 cm, and T2 tumors were more likely to undergo non–organ-preserving therapy vs. radiation or a cosmesis-preserving procedure (all p |
| doi_str_mv | 10.1016/j.brachy.2019.04.007 |
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The National Cancer Database was queried for men with cT1-2N0 penile cancers <4 cm in size. Comparative statistics for treatment modality were generated using bivariate logistic regression analysis.
Among 1235 cases eligible for analysis, median age was 69 years. Median tumor size was 2.0 cm. 95.8% of men underwent surgery alone, with 91 (7.4%) undergoing radical penectomy, 673 (54.5%) partial penectomy, and 419 (33.9%) cosmesis-preserving surgical procedure. Only 4 (0.3%) men were treated with brachytherapy alone, 48 (3.9%) with external-beam radiation therapy (EBRT) alone, and 8 (0.6%) with EBRT after surgery. Surgical margins were positive in 118 (9.6%) patients, 14 of whom received adjuvant EBRT (11.9%) and two adjuvant brachytherapy (1.7%).
There was no difference in demographic or clinical characteristics in groups treated with surgery vs. radiation (all p > 0.2). Age >70, lesions >2 cm, and T2 tumors were more likely to undergo non–organ-preserving therapy vs. radiation or a cosmesis-preserving procedure (all p < 0.05). The propensity-matched 5-year survival was not different between definitive radiation vs. surgery (61.6% vs. 62.2%, p = 0.70).
Men with penile-preserving eligible lesions in the United States are overwhelmingly treated with surgery. Penile-preserving radiation techniques including brachytherapy and EBRT are underutilized and should be offered as curative interventions.</description><identifier>ISSN: 1538-4721</identifier><identifier>EISSN: 1873-1449</identifier><identifier>DOI: 10.1016/j.brachy.2019.04.007</identifier><identifier>PMID: 31126857</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Age Factors ; Aged ; Brachytherapy ; Brachytherapy - statistics & numerical data ; Databases, Factual ; Humans ; Male ; Margins of Excision ; NCDB ; Neoplasm Staging ; Neoplasm, Residual ; Organ Sparing Treatments - statistics & numerical data ; Penile carcinoma ; Penile Neoplasms - pathology ; Penile Neoplasms - radiotherapy ; Penile Neoplasms - surgery ; Practice Patterns, Physicians' - statistics & numerical data ; Radiation ; Radiotherapy, Adjuvant - statistics & numerical data ; Survival Rate ; Tumor Burden ; Underutilization ; United States</subject><ispartof>Brachytherapy, 2019-07, Vol.18 (4), p.503-509</ispartof><rights>2019 American Brachytherapy Society</rights><rights>Copyright © 2019 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c428t-8bf0c4cbee86e2e1ae4d37a4d8d22afd41e62c7b4b343acddeafa9837991bd403</citedby><cites>FETCH-LOGICAL-c428t-8bf0c4cbee86e2e1ae4d37a4d8d22afd41e62c7b4b343acddeafa9837991bd403</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1538472119300844$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65534</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31126857$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mulherkar, Ria</creatorcontrib><creatorcontrib>Hasan, Shaakir</creatorcontrib><creatorcontrib>Wegner, Rodney E.</creatorcontrib><creatorcontrib>Verma, Vivek</creatorcontrib><creatorcontrib>Glaser, Scott M.</creatorcontrib><creatorcontrib>Kalash, Ronny</creatorcontrib><creatorcontrib>Beriwal, Sushil</creatorcontrib><creatorcontrib>Horne, Zachary D.</creatorcontrib><title>National patterns of care for early-stage penile cancers in the United States: How is radiation and brachytherapy utilized?</title><title>Brachytherapy</title><addtitle>Brachytherapy</addtitle><description>Per American Brachytherapy Society guidelines, cT1-2N0 penile cancers <4 cm in diameter are excellent candidates for curative brachytherapy. Using that criterion, we evaluated national patterns of care and predictors of use of radiation techniques using the National Cancer Database.
The National Cancer Database was queried for men with cT1-2N0 penile cancers <4 cm in size. Comparative statistics for treatment modality were generated using bivariate logistic regression analysis.
Among 1235 cases eligible for analysis, median age was 69 years. Median tumor size was 2.0 cm. 95.8% of men underwent surgery alone, with 91 (7.4%) undergoing radical penectomy, 673 (54.5%) partial penectomy, and 419 (33.9%) cosmesis-preserving surgical procedure. Only 4 (0.3%) men were treated with brachytherapy alone, 48 (3.9%) with external-beam radiation therapy (EBRT) alone, and 8 (0.6%) with EBRT after surgery. Surgical margins were positive in 118 (9.6%) patients, 14 of whom received adjuvant EBRT (11.9%) and two adjuvant brachytherapy (1.7%).
There was no difference in demographic or clinical characteristics in groups treated with surgery vs. radiation (all p > 0.2). Age >70, lesions >2 cm, and T2 tumors were more likely to undergo non–organ-preserving therapy vs. radiation or a cosmesis-preserving procedure (all p < 0.05). The propensity-matched 5-year survival was not different between definitive radiation vs. surgery (61.6% vs. 62.2%, p = 0.70).
Men with penile-preserving eligible lesions in the United States are overwhelmingly treated with surgery. Penile-preserving radiation techniques including brachytherapy and EBRT are underutilized and should be offered as curative interventions.</description><subject>Age Factors</subject><subject>Aged</subject><subject>Brachytherapy</subject><subject>Brachytherapy - statistics & numerical data</subject><subject>Databases, Factual</subject><subject>Humans</subject><subject>Male</subject><subject>Margins of Excision</subject><subject>NCDB</subject><subject>Neoplasm Staging</subject><subject>Neoplasm, Residual</subject><subject>Organ Sparing Treatments - statistics & numerical data</subject><subject>Penile carcinoma</subject><subject>Penile Neoplasms - pathology</subject><subject>Penile Neoplasms - radiotherapy</subject><subject>Penile Neoplasms - surgery</subject><subject>Practice Patterns, Physicians' - statistics & numerical data</subject><subject>Radiation</subject><subject>Radiotherapy, Adjuvant - statistics & numerical data</subject><subject>Survival Rate</subject><subject>Tumor Burden</subject><subject>Underutilization</subject><subject>United States</subject><issn>1538-4721</issn><issn>1873-1449</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kM1O3TAQRi1UBBR4A4S87CbBfyQOi1YVogUJwQJYWxN7Ar7KTYLtW3Th5WsIsGQ1luZ8M55DyAFnJWe8OlqUbQD7sC4F403JVMlYvUF2uK5lwZVqvuX3sdSFqgXfJt9jXLAca6TcItuSc1Hp43qHvFxB8uMAPZ0gJQxDpGNHLQSk3RgoQujXRUxwj3TCwfeYe4PFEKkfaHpAejf4hI7eJEgYT-j5-ER9pAGcfxtMYXB0_mimA0xrukq-98_ofu2RzQ76iPvvdZfc_Tm7PT0vLq__Xpz-viysEjoVuu2YVbZF1BUK5IDKyRqU004I6JziWAlbt6qVSoJ1DqGDRsu6aXjrFJO75Mc8dwrj4wpjMksfLfY9DDiuohFCCs7qSumMqhm1YYwxYGem4JcQ1oYz86rdLMx8jXnVbpgyWXuOHb5vWLVLdJ-hD88Z-DkDmO_85zGYaD1mkc4HtMm40X-94T_mgJhS</recordid><startdate>201907</startdate><enddate>201907</enddate><creator>Mulherkar, Ria</creator><creator>Hasan, Shaakir</creator><creator>Wegner, Rodney E.</creator><creator>Verma, Vivek</creator><creator>Glaser, Scott M.</creator><creator>Kalash, Ronny</creator><creator>Beriwal, Sushil</creator><creator>Horne, Zachary D.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201907</creationdate><title>National patterns of care for early-stage penile cancers in the United States: How is radiation and brachytherapy utilized?</title><author>Mulherkar, Ria ; Hasan, Shaakir ; Wegner, Rodney E. ; Verma, Vivek ; Glaser, Scott M. ; Kalash, Ronny ; Beriwal, Sushil ; Horne, Zachary D.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c428t-8bf0c4cbee86e2e1ae4d37a4d8d22afd41e62c7b4b343acddeafa9837991bd403</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Age Factors</topic><topic>Aged</topic><topic>Brachytherapy</topic><topic>Brachytherapy - statistics & numerical data</topic><topic>Databases, Factual</topic><topic>Humans</topic><topic>Male</topic><topic>Margins of Excision</topic><topic>NCDB</topic><topic>Neoplasm Staging</topic><topic>Neoplasm, Residual</topic><topic>Organ Sparing Treatments - statistics & numerical data</topic><topic>Penile carcinoma</topic><topic>Penile Neoplasms - pathology</topic><topic>Penile Neoplasms - radiotherapy</topic><topic>Penile Neoplasms - surgery</topic><topic>Practice Patterns, Physicians' - statistics & numerical data</topic><topic>Radiation</topic><topic>Radiotherapy, Adjuvant - statistics & numerical data</topic><topic>Survival Rate</topic><topic>Tumor Burden</topic><topic>Underutilization</topic><topic>United States</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mulherkar, Ria</creatorcontrib><creatorcontrib>Hasan, Shaakir</creatorcontrib><creatorcontrib>Wegner, Rodney E.</creatorcontrib><creatorcontrib>Verma, Vivek</creatorcontrib><creatorcontrib>Glaser, Scott M.</creatorcontrib><creatorcontrib>Kalash, Ronny</creatorcontrib><creatorcontrib>Beriwal, Sushil</creatorcontrib><creatorcontrib>Horne, Zachary D.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Brachytherapy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mulherkar, Ria</au><au>Hasan, Shaakir</au><au>Wegner, Rodney E.</au><au>Verma, Vivek</au><au>Glaser, Scott M.</au><au>Kalash, Ronny</au><au>Beriwal, Sushil</au><au>Horne, Zachary D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>National patterns of care for early-stage penile cancers in the United States: How is radiation and brachytherapy utilized?</atitle><jtitle>Brachytherapy</jtitle><addtitle>Brachytherapy</addtitle><date>2019-07</date><risdate>2019</risdate><volume>18</volume><issue>4</issue><spage>503</spage><epage>509</epage><pages>503-509</pages><issn>1538-4721</issn><eissn>1873-1449</eissn><abstract>Per American Brachytherapy Society guidelines, cT1-2N0 penile cancers <4 cm in diameter are excellent candidates for curative brachytherapy. Using that criterion, we evaluated national patterns of care and predictors of use of radiation techniques using the National Cancer Database.
The National Cancer Database was queried for men with cT1-2N0 penile cancers <4 cm in size. Comparative statistics for treatment modality were generated using bivariate logistic regression analysis.
Among 1235 cases eligible for analysis, median age was 69 years. Median tumor size was 2.0 cm. 95.8% of men underwent surgery alone, with 91 (7.4%) undergoing radical penectomy, 673 (54.5%) partial penectomy, and 419 (33.9%) cosmesis-preserving surgical procedure. Only 4 (0.3%) men were treated with brachytherapy alone, 48 (3.9%) with external-beam radiation therapy (EBRT) alone, and 8 (0.6%) with EBRT after surgery. Surgical margins were positive in 118 (9.6%) patients, 14 of whom received adjuvant EBRT (11.9%) and two adjuvant brachytherapy (1.7%).
There was no difference in demographic or clinical characteristics in groups treated with surgery vs. radiation (all p > 0.2). Age >70, lesions >2 cm, and T2 tumors were more likely to undergo non–organ-preserving therapy vs. radiation or a cosmesis-preserving procedure (all p < 0.05). The propensity-matched 5-year survival was not different between definitive radiation vs. surgery (61.6% vs. 62.2%, p = 0.70).
Men with penile-preserving eligible lesions in the United States are overwhelmingly treated with surgery. Penile-preserving radiation techniques including brachytherapy and EBRT are underutilized and should be offered as curative interventions.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>31126857</pmid><doi>10.1016/j.brachy.2019.04.007</doi><tpages>7</tpages></addata></record> |
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| subjects | Age Factors Aged Brachytherapy Brachytherapy - statistics & numerical data Databases, Factual Humans Male Margins of Excision NCDB Neoplasm Staging Neoplasm, Residual Organ Sparing Treatments - statistics & numerical data Penile carcinoma Penile Neoplasms - pathology Penile Neoplasms - radiotherapy Penile Neoplasms - surgery Practice Patterns, Physicians' - statistics & numerical data Radiation Radiotherapy, Adjuvant - statistics & numerical data Survival Rate Tumor Burden Underutilization United States |
| title | National patterns of care for early-stage penile cancers in the United States: How is radiation and brachytherapy utilized? |
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